Primary care as I knew it, is now unrecognizable. It has moved from patient centered to policy centered. So many primary cares are being eaten up by hospitals, corporate physician groups, and insurances that patients are left as pawns in the commodity game. Patient voices are a distant echo in the ever changing landscape of today’s health. There is only an illusion of patient centered care as it only occurs if it fits within the often impersonal and unyielding policies and procedures.
We, as patients, are caught in the web because we need need healthcare. It is difficult to find a primary care practice that is accepting patients, your insurance, or your medical history. For many, without a primary care provider, there can be no speicalty services. Our insurance policies dictate our movements and when we challenge, we must fight the good fight to get the care we need paid for.
I digress. I have three reasons why Primary Care needs a make over.
1. I don’t find PCPs invested in the concept of care coordinator. It is so much easier to field all the problems to specialists without following up. The personal touch and caring is rare. I understand that PCPs are under the gun by their institutions to be productive. These days, it is all about the numbers.
2. Institutional policies and procedures have crippled the primary care doctor. Bureaucracy has taken hold of care practice. PCPs, unless independent must adhere to whatever policies and procedures for care are instituted by their organizations. There is little time for creative thinking or independent thought. Here is an example of a non patient centered policy. A client calls the on call doctor for their husband who hurt his back looking for a muscle relaxer. Her husband never gets sick and takes no medication. The on call doctor informs her, “it had been over a year since he was seen and the policy said he couldn’t do anything. Go to the urgent care.” How was anyone supposed to know about this policy? It wasn’t posted anywhere.
3. EMRs no longer paint a true picture of patients and PCPs are beholden to the EMR. As the larger networks are being crafted and refined, patients are only what is reflected in the EMR. The EMRS are not descriptors of a person anymore but a composite of a drop down menu selection. Ten years ago, there would have been note about the husband being healthy and coming in when necessary. No longer. He is, as per the policy, not a follower of the dictated behavior and therefore not accepted. It is as if he has been sent to collections and now needs to pay up before receiving any further care.
Perhaps I long for the good old days when the family doctor or primary doctor was invested in knowing the patient and being an advocate. Primary care is in need of a make over. There is a need to redefine itself as the most important part of our healthcare system. In doing that, there needs to be a re-examination of the relationship forged between the patient and provider.